Table of Contents

Chapter 2: Initial Treatment: Weighing the Pros and Cons of Each Option

i. Tailoring Treatment to Your Disease

There are three clinical factors that doctors will look at in determining whether surgery or radiation therapy might be the right course.

The most significant clinical factor that might sway your decision one way or another is the extent of your tumor. If your cancer has spread beyond the capsule, or outermost layer, of the prostate, surgery might not be the best choice for you. In fact, for some surgeons, this factor alone would cause them to counsel you away from this treatment approach. However, this requires that the surgeon would know in advance exactly where the tumor ends and where the healthy tissue begins. As we noted earlier, because this is not always possible, it is imperative that if you choose surgery, you choose a surgeon whom you trust can make a well-educated decision to alter the original plan should it prove necessary.

On the other hand, tumors that are confined to the prostate are also excellent candidates for radiation therapy. The radiation oncologist will have an easier time planning out the doses, and the likelihood of damage to the surrounding organs is very small. But remember that accurate dose planning is crucial to good outcomes. Be sure to choose a radiation oncologist  who has considerable experience in the type of treatment you select.

If the extent of the tumor turns out not to be the deciding factor, overall health might be. Prostatectomy, even if done laparoscopically, is major surgery. Heart disease, breathing difficulties such as asthma or emphysema, and blood clotting problems can all be factors that work against you when deciding whether surgery is appropriate. Be sure your doctors know about all of your health problems so they can help you can make the most well-informed decision possible.

For radiation therapy, your overall health status is typically less of an issue. The x-rays are so focused on the prostate that there are few, if any, effects seen outside of the local area. Fatigue, however, is common as treatment progresses, especially if higher doses are used to better kill the cancer cells. Plan to keep a lighter schedule during your course of radiation, and allow for some additional relaxation or nap time each treatment day.

The third clinical factor is age. Traditionally, it was assumed that younger men fared better with surgery and older men fared better with radiation therapy. Today, few doctors take such a polarizing viewpoint on age. Instead, they use age as a surrogate for longevity: if you have a life expectancy of less than 10 years, surgery is probably not the best option, and radiation therapy might be a better choice.

The reasoning behind this approach is somewhat complicated. Partly it relates to overall health, because it is assumed that older men will have other illnesses that will make them less than ideal candidates for surgery. And partly it relates to a general sense that people who have limited years ahead of them shouldn’t have to undergo the long recovery from surgery if a less onerous treatment strategy is available. For many doctors, men who are above age 75 will likely be counseled away from prostatectomy and toward radiation therapy or active surveillance.